title: Fatigue in myasthenia gravis: is it more than muscular weakness?
abstract: BACKGROUND
  Few studies have focused on fatigue in myasthenia gravis (MG), and fatigue in relation to the autonomic system has never been systematically explored in these patients. The study aimed to document the prevalence of MG-related fatigue in ethnic Norwegians and to examine whether MG severity is associated with symptoms of autonomic disturbance, which in turn is associated with fatigue and functional disability.
  
  
  METHODS
  Eighty two of the 97 who fulfilled the study inclusion criteria participated in the study. Controls were 410 age- and sex-matched subjects drawn from a normative sample (n = 2136) representative of the Norwegian population. Bivariate analyses and multivariate linear regression analyses were used to assess associations between questionnaire-reported MG severity, symptoms of autonomic disturbance, fatigue (mental and physical) and functional disability.
  
  
  RESULTS
  Forty-four per cent (36/82) of patients fulfilled the criteria for fatigue compared with 22% (90/410) of controls (odds ratio 2.0; p = 0.003). Twenty-one per cent of patients (17/82) met the criteria for chronic fatigue versus 12% (48/410) of controls (odds ratio 1.96; p = 0.03). MG patients had higher total fatigue scores than controls (p < 0.001) and a high prevalence of autonomic symptoms, especially poor thermoregulation and sleep disturbance. According to multivariate analyses controlled for MG score, symptoms of autonomic disturbances were independently positively associated with fatigue (p < 0.001), and fatigue was independently negatively associated with functional level (p < 0.001).
  
  
  CONCLUSIONS
  Norwegian ethnic patients with MG have higher levels of fatigue and a higher prevalence of chronic fatigue than controls, even in patients in full remission. MG severity is highly suggestive to be associated with symptoms of autonomic disturbance, which in turn is associated with fatigue and the level of functional disability.
authors.affiliation: Department of Neurology, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, 0424 Oslo, Norway. ahmed.elsais@medisin.uio.no.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsais
authors.forename: Vegard B
authors.initials: VB
authors.lastname: Wyller
authors.forename: Jon Håvard
authors.initials: JH
authors.lastname: Loge
authors.forename: Emilia
authors.initials: E
authors.lastname: Kerty
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005221:Fatigue / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009157:Myasthenia Gravis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D009460:Neurologic Examination; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors